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Fill and Sign the Columbia Community Transcript Form

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Hoosier Motor Club 2010 School Safety Patrol Merit Awards and Certificate Order Form Please send the following AAA awards for our School Safety Patrol Honors Day Program. Deadline – April 16, 2010 Quantity Item _______ Merit Pins Black and silver lapel pin in the shape of a miniature Patrolman badge for all who satisfactorily served on the School Safety Patrol during the 2009-10 school year. _______ Special Recognition Merit Pins – (maximum 3 per school) Black and gold lapel pin in the shape of a miniature Patrolman badge to honor exemplary patrollers (student or adult) who have performed outstanding services throughout the 2009-10 school year. _______ Award of Merit Certificate For all students who satisfactorily served as a member on the School Safety Patrol during the 2009-10 school year. _______ SSP Supervisor’s Certificate Recognizes adult supervisors. _______ Adult Crossing Guard Certificate of Appreciation Recognizes Adult School Crossing Guards. Adult Service Pins Please indicate quantity for each year 5 years ____ 10 years ____ 15 years ____ 20 years ____ 25 years ____ School Name or Enforcement Agency ___________________________________________ Street Address _____________________________________________________________ City _______________________________________ Zip ___________________________ Date _________________________ Ordered by __________________________________ Email Address ______________________________________________________________

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